How to treat early-stage lung adenocarcinoma based on the size of the clinical solid component?
Year: 2020
Type: letter
Abstract: In the recently published article by Han et al. [1], the authors performed a retrospective analysis of patients with early-stage lung adenocarcinoma. This study demonstrated that the prognosis of patients with ground glass opacity (GGO)-dominant lesions was not significantly different from that of patients with solid-dominant lesions in patients with a similar invasive component size <20 mm. Additional multivariable analyses were performed and showed that the size of the clinical solid component size in early-stage lung adenocarcinoma was a strong predictor of survival. Therefore, the size of the clinical solid component should be considered when determining the treatment strategy for these patients. Here comes the question on how we should treat early-stage lung adenocarcinoma based on the size of the solid portion. A good correlation between radiological evaluation and pathological findings regarding the GGO component has been reported in early-stage lung cancer. Most surgeons select the treatment strategy mainly based on high-resolution computed tomography measurements. Tsutani et al. [2] demonstrated that GGO-dominant (consolidation/tumour ratio, C/T ratio <0.5) early-stage lung adenocarcinoma with tumour size <2 cm was associated with an excellent prognosis. There was no significant difference in recurrence-free survival among patients who underwent lobectomy and sublobar resection. However, a recent publication of the Japan Lung Cancer Surgical Study Group (JCOG LCSSG) [3] demonstrated that the optimal cut-off value for the C/T ratio should be re-evaluated in patients with a tumour size <2 cm. They concluded that a cut-off value of 0.25 showed the highest specificity in defining radiologically non-invasive lung cancer, which has been confirmed in some studies [4, 5]. In contrast, there are no clear cut-offs for the size of the clinical solid component at present and it remains unclear whether it is helpful to determine what kind of surgery should be conducted. Of interest, Han et al. [1] concluded that operative methods and GGO ratio did not significantly affect the prognosis in 544 patients with node-negative adenocarcinomas with an invasive component size <2 cm. So, does this mean it is reasonable that we advocate sublobar resection in these patients because use of sublobar resection could yield a comparable prognosis to lobar resection? Clinicians have been looking for better ways to select suitable patients for sublobar resection without compromising prognosis. We wish they had included more details about their operative method, which may be helpful in clinical practice.
Authors: Hui Ma, Guoqing Zhang
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3023647816